We Have a Problem — a Big Problem

by George Pennebaker, Pharm.D.Reporters from a major metropolitan newspaper took prescriptions for drugs that had serious interaction potentials to a significant number of pharmacies. In the vast majority of the pharmacies, there was no indication that anything was done to deal with the interaction issue.

Chicago Tribune reporters (15 of them) took prescriptions for pairs of interacting drugs to 255 pharmacies in the Chicago area. The pairs were chosen by pharmacist consultants with drug interaction expertise. Most of the pharmacies failed to contact the prescriber or orally warn the waiting “patient.” Independent pharmacies failed 72% of the time. Chain pharmacies failed 30% to 63% of the time. Location did not matter. The headline in the Dec. 15, 2016, Chicago Tribune was: “Pharmacies miss half of dangerous drug combinations.”

Daniel Hussar, a highly respected expert on drug therapy and pharmacy issues, commented on the Chicago Tribune investigation in the January 2017 issue of The Pharmacist Activist, a monthly publication that he writes. Dan’s discussion is required reading for anyone interested in this problem.

Both publications thoroughly examined the causes of this problem. Neither had groundbreaking solutions.

ComputerTalk is read by both pharmacists and pharmacy computer systems people. All of you: Go back and read my first paragraph again.

We have a problem. It’s not the time to point fingers at each other. It’s the time to get together and figure out how to deal with this shared problem. It is a major patient care issue. People believe that we (pharmacists, pharmacies, and computer systems) are preventing drug interactions. The investigation showed that we only catch them about 50% of the time. Fifty percent is a failing grade. An F.

In the early 1970s I spent a whole summer entering the data for a drug interaction feature we were creating for our pioneering pharmacy system. I pored over the two drug interaction books that had been published, deciding which interactions would be included in our system. It was not an easy task. The whole concept of drug interactions was new; there were not as many as we have today, and it was more difficult to decide which ones had solid evidence. Where are we now? Some points to consider:

Pharmacists do not have enough time to deal with interactions. Checking interactions interrupts production flow. More Rx’s per day equals more fees per day. And the boss likes more fees per day.

The cry-wolf factor. A lot of them are not important, which can mean ignoring the important ones as well.

The statistical conundrum. Is this patient the one in a million who gets a significant reaction? Or is this a one-in-a-million issue — so it can’t be this patient, she or he is one of the 999,999. Can the computers help with the seriousness issue?

Should the systems generate interaction statistics that will help management understand why some prescriptions take longer than others?

All pharmacy types had the same problem. It’s not the other guys.

Are there better ways to communicate with prescribers when these patient issues arise?

What are the relative responsibilities of prescribers, pharmacists, patients, and computer systems? Should they be changed?

Side note: In the 1970’s some of our corporate pharmacy prospects told us that they did not want the interaction alerts because their lawyers said it would increase the company’s liability risks. Were they right? It is not just a PR problem. It is a healthcare systems problem. It is a patient care problem. And it could come to be a big legal problem.

This column is the shortest one I have written in 30 years of columns for ComputerTalk. It is short because the problem is clear. Drug interaction prevention urgently needs attention. Its current failures will not fade away on their own.

What are you going to do to make drug interaction detection affect patient care?

Here is my suggested cure: Program the computer systems to automatically print out, and include in the paperwork given to the patient, a description of the interaction that has been detected.

We all understand that the more a patient understands about his or her condition and therapy, the better the result will be.

Pharmacists will have to answer the question: “Why didn’t you tell me about this?”

There also needs to be a way to tell the corporate data freaks that this patient will take a little more time. CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at george.pennebaker@sbcglobal.net; 916/501-6541; and PO Box 25, Esparto, CA 95627.